Will Insurance Pay for Breast Augmentation After Spinal Fusion?

At age 9 I had spinal fusion with fixation and removal of my growth plates. I am now almost 18 and am teased on a regular basis for not having any breasts. Truth be known I am barely an "a" cup.

Doctor Answers (11)

No, insurance does not cover cosmetic breast augmentation

+1

No, insurance does not cover cosmetic breast augmentation. Breast augmentation is an elective surgery to increase the size of your breasts.

Usually, if the goal of a procedure is to improve appearance or boost self-esteem, it is not covered by insurance.

In order for a procedure to be deemed medically necessary, it has to correct a functional or medical problem.


Nashville Plastic Surgeon
5.0 out of 5 stars 41 reviews

Breast augmentation

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Breast augmentation is a cosmetic procedure and is not covered by insurance.  If you had a breast deformity due to say Poland's syndrome then it may be covered.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast Reconstruction for lack of development

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Hi there-

We have had success (but RARELY) in cases like yours. It will be very important for you to be able to prove that the surgery you had on your back directly led to the lack of development of your breasts.

Good luck!

 

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 113 reviews

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Insurance will not cover breast augmentation surgery

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I fail to see the correlation between spinal fusion surgery and under development of breast tissue. I'm afraid insurance adjuster won't see it either. But, don't loose heart! Breast augmentation surgery is much more affordable now than in past years. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 134 reviews

Unlikely insurance will cover

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I do not believe insurance will cover a breast augmentation request.  I am also not sure your spinal fusion had anything to do with your breast development.

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 87 reviews

Spinal fusion and breast augmentation

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No, insurance will not pay for a breast augmentation notwithstanding your belief that the spinal fusion somehow impacted the growth of the breasts.  This is not documented in the literature. Additionally, if you have had spinal surgery, there would be a question of how the weight of augmented breasts would affect your orthopedic condition.  Insurance companies are so difficult these days that they deny cases of Pollan syndrome, in which there is lack of breast development.  It is a developmental disorder which has implications for patients and can be documented but, nevertheless, the insurers do not find functional medical necessity.  I think what you have is a confluence of two circumstances which are medically unrelated.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast augmenation coverage and lightening strikes

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The issues with insurance coverage hinge on causation and medical necessity, and if you can show that a medical condition, spinal fusion, caused lack of breast development then implants for 'breast reconstruction' may be covered. Forget medical necessity for despite your small size your breasts will work just fine. The way to see if your insurance will cover is a predetermination process with your carrier by the plastic surgeon. We sometimes try, and yes, lightening does indeed strike.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 31 reviews

Insurance Coverage For Breast Augmentation

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It will be very hard to link the spinal fusion to small breasts, and even if you could, insurance is very unlikely to cover it.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 20 reviews

Don't get your hopes up

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Now a days, insurance doesn't cover necesessary procedures, it is hard to believe that with a spinal fusion they took away breast tissue. Many women have small breasts, that's just nature. Good luck.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Breast Augmentation after Spinal Fusion?

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Thank you for the question.

If there is enough  evidence/documentation that the breast hypoplasia is secondary to the spine “deformity” or fusion,  then there's a chance that health insurance may cover “breast reconstruction”.

If you feel that this is the case,  ask for as much documentation as possible from your primary care physician and spine surgeon. Then, visit with a well experienced board-certified plastic surgeon. He/she will help you check with your insurance company regarding possible coverage.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 793 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.